Miller E, Vurdien J E, White J M
Commun Dis Rep CDR Rev. 1992 Dec 4;2(13):R152-4.
Recovery in the uptake of whole-cell pertussis vaccine from 30% in 1978 to 91% in 1992 has resulted in a major reduction in the incidence of pertussis and in the proportion of cases occurring in pre-school children. This has been accompanied by a decline in pertussis mortality rates, with no deaths reported since September 1990. Seventy-four per cent of the 50 fatal cases reported since 1980 have been infants under one year of age, demonstrating the importance of completing primary immunisation as early as possible after birth. There is no evidence, as yet, that introduction of the accelerated immunisation schedule in June 1990 has reduced the proportion of cases occurring in infants, suggesting that the decline in mortality during the last two years is largely due to indirect protection provided by the current high level of vaccine-induced herd immunity. If 90% coverage is sustained and there is no significant waning of immunity with age, the circulation of Bordetella pertussis should be sufficiently reduced to interrupt the four year epidemic cycle for the first time in the United Kingdom. The hypothesis that vaccine-induced immunity has a serotype-specific component is supported by recent changes in serotype prevalence which have followed the increase in vaccine coverage. Given the successful reinstatement of whole-cell vaccine in the UK immunisation programme, the case for replacing it with a new acellular preparation will require careful evaluation.
全细胞百日咳疫苗的接种率从1978年的30%上升至1992年的91%，这使得百日咳的发病率以及学龄前儿童病例的比例大幅下降。与此同时，百日咳死亡率也有所下降，自1990年9月以来未报告有死亡病例。自1980年报告的50例致命病例中，74%为一岁以下婴儿，这表明尽早在出生后完成基础免疫的重要性。目前尚无证据表明1990年6月实施的加速免疫程序降低了婴儿病例的比例，这表明过去两年死亡率的下降主要归因于当前高水平的疫苗诱导群体免疫所提供的间接保护。如果维持90%的覆盖率且免疫力不会随年龄显著减弱，那么百日咳博德特氏菌的传播应会充分减少，从而在英国首次中断四年的流行周期。疫苗诱导的免疫具有血清型特异性成分这一假设得到了血清型流行率近期变化的支持，这些变化是随着疫苗覆盖率的提高而出现的。鉴于全细胞疫苗在英国免疫计划中的成功恢复，用新的无细胞制剂替代它的理由需要仔细评估。
